Posted on 12/08/2024 7:12:57 AM PST by TigerClaws
The fatal shooting of UnitedHealthcare (UNH) CEO Brian Thompson on Wednesday has sparked public scrutiny of health insurers, especially regarding their use of AI in evaluating claims. The incident also comes as several insurance providers have been facing litigation over their coverage practices and the potential impact they have on patient care.
Thompson was fatally shot in New York City on Wednesday morning, just hours before he was set to speak at the insurance firm’s annual investor day.
Multiple outlets reported on Thursday that shell casings from the shooting had the words “deny,” “defend,” and “depose” written on them. The words appear to reference terms industry critics use to describe how insurers deny claims.
At the same time, posts on social media have been claiming that UnitedHealthcare’s claim-denial rate is the highest in the industry; however, since insurers try to keep these numbers hidden, the true extent of its denials remains uncertain, especially when it comes to private plans.
Still, some recent reports show that denials for some patients have been on the rise.
In October, a report from the U.S. Senate Permanent Subcommittee on Investigations showed that the nation’s insurers have been using AI-powered tools to deny some claims from Medicare Advantage plan subscribers.
The report found that UnitedHealthcare’s denial rate for post-acute care — health care needed to transition people out of hospitals and back into their homes — for people with Medicare Advantage plans rose to 22.7% in 2022, from 10.9% in 2020. Advertisement
The rise coincides with UnitedHealthcare’s implementation of an AI model called nH Predict, originally developed by naviHealth, a subsidiary of UnitedHealth Group that has since been rebranded.
(Excerpt) Read more at yahoo.com ...
I can remember reading/hearing instances of this policy long before AI became the watchword. Just a standard practice to automatically deny and/or delay payments for most any trumped up reason.
So what? AI is written by humans, well, “computer engineers” they call themselves.
Anyhoo, Like any program, it does what the coder wrote. If it behaving unethically, that is the human’s fault.
As to using AI to analyze data, again, so what? A room full of monkeys could do the same. The data is what matters and the criteria to sift thru it. AI just speeds the process.
Related story:
A class action lawsuit filed on November 14, 2023, in the US District Court in Minnesota alleged that UnitedHealth Group and its subsidiaries, UnitedHealthcare and Navihealth, were guilty of using AI technology “in place of real medical professionals to wrongfully deny elderly patients care.”
According to the suit, the companies were aware that the AI model had a 90% error rate in evaluating their claims and had overridden the determinations made by both patients’ physicians.
https://www.thestreet.com/technology/unitedhealthcare-spotlight-reveals-pivotal-ai-failure
Simple...don’t sign up for a Medicare Part C “dis-Advantage” plan. (Unless you like HMO/PPO restrictive Dr. networks, and “pre-approvals”. Reg. Medicare with a supp. plan works just fine.
Health insurance is this form of public-private socialism that supposedly covers most everything. I’m not sure it should be.
Car insurance, for example, typically covers events such as accidents and other major events, not routine maintenance or repairs.
Home insurance does not cover routine maintenance or repairs, but major or catastrophic issues. It doesn’t even cover certain infestations, such as termites.
Maybe if health insurance worked more like car or home insurance, only covering things like surgeries, major illnesses or cancer, there wouldn’t be this level of acrimony.
We’ve had UHC for several years. Surgeries, urologists, orthopedists, dermatologists, primary care and more. Never had a claim denied.
If capitalism actually functioned well, and wasn’t so beset with this level of corporate corruption — there wouldn’t be so many Democrats and battleground states. Many a Republicam-turned-Democrat voter has a devastating denied insurance claim created. People associate the current insurance hierarchy with unchecked (corporate) capitalism. And blame Republicans. Esp the establishment kind.
IOW, the AI had no conscience? Like some humans might?
You are lucky, those who have had to resort to “gofundme’s” and other desperate measures to pay for time sensitive surgeries and treatments end up becoming part of the Democrat voting block in favor of some form of universal healthcare. (Which comes with its own terrible baggage.)
Basically it’s this kind if manifestation (corporate) capitalism that leads to socialist-to-outright communist tendencies among the populace. In any country really.
The correct term for this is fascism. And look what happened to Mussolini and his cronies. In a just system that would be murder, but the crooks and frauds would be in jail and their families would be bankrupt.
Yep. Medicare plus a supplement. That’s the route Mr sneakers and I chose to go. We’ve been very happy with it.
At this point it is hard to believe that a National Health Service version of socialized medicine would be more expensive than what we’ve got. Losers would be people who still have really high priced health insurance from their employer, but the employers would be free to continue that, as they are free to do in Europe.
Between the lack of coverage and the amount of confusion and red tape required to have any routine procedure approved and paid for, the dissatisfaction of the American public is exceedingly high. Doctors, Hospital Chains, Insurers and Drug Companies should be taking note of their political risks.
Any evidence, based on statistical sampling of actual claims history, that claims are commonly being improperly denied?
I heard that about United years ago - people had to fight them to get them to pay.
“And blame Republicans. Esp the establishment kind.”
************
There are precious few Republicans that fight for anything. Most of them are passive enablers. Trump may change that for awhile, but the GOP will inevitably regress back to its mean (i.e., rank politicians who talk big and produce little).
There’s a reason why Warren Buffett loves insurance companies.
AI mimics human responses. That is technologically fantastic, but it doesn't mean infallible oracle or super-genius.
I think we should BAN the use of A.I. for life and death decisions of any type.
The A.I. may decide the ‘efficient solution’ is to just kill off humanity.
John Connor agrees.
Medicare Advantage is a ripoff from the beginning.
With the government’s blessing, you’re hiring a private, for-profit third party (insurance companies) to stand between you and your federal Medicare benefit.
Their purpose is to ration your access to healthcare and to deny expensive treatments that are covered by your federal benefit.
The misleading and supposed benefits that Medicare Advantage offer are inexpensive and incomplete items and are easily paid for out-of-pocket by the average consumer.
The government is subsidizing Medicare Advantage plans precisely because it rations healthcare, just like Canadian and European national health systems.
It’s the entry to socialized medicine and healthcare in America, they’re just not telling us that that’s what it is.
Advantage plans are the number 1 plan that’s dropped by consumers every year.
Once people find out about the restrictions and rationing they drop it like a hot potato.
It’s not surprising at all if someone’s benefits were denied and they were angry enough to seek vengeance, particularly if their diagnosis was terminal because of the denial of benefits.
We don’t yet know why the murder took place, but this should be a wake up call to the entire system of Medicare Advantage plans and those who deny benefits for profit.
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